{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T17:48:36Z","timestamp":1777916916385,"version":"3.51.4"},"reference-count":42,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2019,8,20]],"date-time":"2019-08-20T00:00:00Z","timestamp":1566259200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"The White Rose University Consortium","award":["NA"],"award-info":[{"award-number":["NA"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Med Decis Making"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:p>Introduction. Individuals from older populations tend to have more than 1 health condition (multimorbidity). Current approaches to produce economic evidence for clinical guidelines using decision-analytic models typically use a single-disease approach, which may not appropriately reflect the competing risks within a population with multimorbidity. This study aims to demonstrate a proof-of-concept method of modeling multiple conditions in a single decision-analytic model to estimate the impact of multimorbidity on the cost-effectiveness of interventions. Methods. Multiple conditions were modeled within a single decision-analytic model by linking multiple single-disease models. Individual discrete event simulation models were developed to evaluate the cost-effectiveness of preventative interventions for a case study assuming a UK National Health Service perspective. The case study used 3 diseases (heart disease, Alzheimer\u2019s disease, and osteoporosis) that were combined within a single linked model. The linked model, with and without correlations between diseases incorporated, simulated the general population aged 45 years and older to compare results in terms of lifetime costs and quality-adjusted life-years (QALYs). Results. The estimated incremental costs and QALYs for health care interventions differed when 3 diseases were modeled simultaneously (\u00a3840; 0.234 QALYs) compared with aggregated results from 3 single-disease models (\u00a3408; 0.280QALYs). With correlations between diseases additionally incorporated, both absolute and incremental costs and QALY estimates changed in different directions, suggesting that the inclusion of correlations can alter model results. Discussion. Linking multiple single-disease models provides a methodological option for decision analysts who undertake research on populations with multimorbidity. It also has potential for wider applications in informing decisions on commissioning of health care services and long-term priority setting across diseases and health care programs through providing potentially more accurate estimations of the relative cost-effectiveness of interventions.<\/jats:p>","DOI":"10.1177\/0272989x19868987","type":"journal-article","created":{"date-parts":[[2019,8,21]],"date-time":"2019-08-21T02:11:00Z","timestamp":1566353460000},"page":"842-856","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Modeling the Economic Impact of Interventions for Older Populations with Multimorbidity: A Method of Linking Multiple Single-Disease Models"],"prefix":"10.1177","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1382-495X","authenticated-orcid":false,"given":"Ji-Hee","family":"Youn","sequence":"first","affiliation":[{"name":"Manchester Centre for Health Economics, Faculty of Biology, Medicine and Health, the University of Manchester, Oxford Road, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matt D.","family":"Stevenson","sequence":"additional","affiliation":[{"name":"School of Health and Related Research, the University of Sheffield, Regent Court, Sheffield, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Praveen","family":"Thokala","sequence":"additional","affiliation":[{"name":"School of Health and Related Research, the University of Sheffield, Regent Court, Sheffield, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Payne","sequence":"additional","affiliation":[{"name":"Manchester Centre for Health Economics, Faculty of Biology, Medicine and Health, the University of Manchester, Oxford Road, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Goddard","sequence":"additional","affiliation":[{"name":"Centre for Health Economics, the University of York, Heslington, York, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2019,8,20]]},"reference":[{"key":"bibr1-0272989X19868987","volume-title":"Ready for Ageing?","author":"House of Lords","year":"2013"},{"key":"bibr2-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60240-2"},{"key":"bibr3-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-016-3335-z"},{"key":"bibr4-0272989X19868987","volume-title":"Long Term Conditions Compendium of Information","author":"Department of Health","year":"2012","edition":"3"},{"key":"bibr5-0272989X19868987","unstructured":"The King\u2019s Fund. Long-term conditions and multi-morbidity. Future trends. April 5, 2017. Available from: https:\/\/www.kingsfund.org.uk\/time-to-think-differently\/trends\/disease-and-disability\/long-term-conditions-multi-morbidity"},{"key":"bibr6-0272989X19868987","volume-title":"The 2010 National Survey of Residential Care Facilities","author":"The National Center for Health Statistics","year":"2010"},{"key":"bibr7-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.1016\/j.arr.2011.03.003"},{"key":"bibr8-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-2-51"},{"key":"bibr9-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp12X636146"},{"key":"bibr10-0272989X19868987","first-page":"345","author":"Guthrie B","year":"2012","journal-title":"BMJ"},{"key":"bibr11-0272989X19868987","volume-title":"Better Guidelines for Better Care: Accounting for Multimorbidity in Clinical Guidelines","author":"Guthrie B","year":"2015"},{"key":"bibr12-0272989X19868987","volume-title":"Surveying, Assessing and Analysing the Pharmaceutical Sector in the 25 EU Member States","author":"Habl C","year":"2006"},{"key":"bibr13-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.1017\/S0266462300101060"},{"key":"bibr14-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.6.716"},{"key":"bibr15-0272989X19868987","first-page":"354","author":"Farmer C","year":"2016","journal-title":"BMJ"},{"key":"bibr16-0272989X19868987","volume-title":"Developing NICE Guidelines: The Manual","author":"National Institute for Health and Care Excellence","year":"2014"},{"key":"bibr17-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.1002\/hec.3366"},{"key":"bibr18-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.1007\/BF03391611"},{"key":"bibr19-0272989X19868987","volume-title":"Statins for the Prevention of Coronary Events","author":"Ward S","year":"2006"},{"key":"bibr20-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.3310\/hta16210"},{"key":"bibr21-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.3310\/hta13450"},{"key":"bibr22-0272989X19868987","volume-title":"Guide to the Methods of Technology Appraisal","author":"National Institute for Health and Care Excellence","year":"2013"},{"key":"bibr23-0272989X19868987","volume-title":"Population Estimates for UK, England and Wales, Scotland and Northern Ireland, Mid-2012","author":"Office for National Statistics","year":"2013"},{"key":"bibr24-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.1093\/oso\/9780198526629.001.0001"},{"key":"bibr25-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-017-0551-z"},{"key":"bibr26-0272989X19868987","volume-title":"Interim Life Tables, England and Wales, 2009-2011","author":"Office for National Statistics","year":"2013"},{"key":"bibr27-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.2006.01687.x"},{"issue":"5","key":"bibr28-0272989X19868987","volume":"3","author":"Warburton DER","year":"2007","journal-title":"Vasc Health Risk Manag"},{"key":"bibr29-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afq146"},{"key":"bibr30-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.1359\/JBMR.050711"},{"key":"bibr31-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.007195"},{"key":"bibr32-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.62.1.107"},{"key":"bibr33-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.1137\/1.9781611970319"},{"key":"bibr34-0272989X19868987","volume-title":"Cardiovascular Disease: Risk Assessment and Reduction, Including Lipid Modification","author":"National Institute for Health And Care Excellence","year":"2014"},{"key":"bibr35-0272989X19868987","volume-title":"Donepezil, Galantamine, Rivastigmine and Memantine for the Treatment of Alzheimer\u2019s Disease","author":"National Institute for Health and Care Excellence","year":"2011"},{"key":"bibr36-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afs165"},{"key":"bibr37-0272989X19868987","volume-title":"Sampling: Design and Analysis","author":"Lohr SL.","year":"2009","edition":"2"},{"key":"bibr38-0272989X19868987","unstructured":"Academy of Medical Sciences. Multimorbidity: a priority for global health research. 2018. Available from: https:\/\/acmedsci.ac.uk\/policy\/policy-projects\/multimorbidity."},{"key":"bibr39-0272989X19868987","volume-title":"Better Guidelines for Better Care: Accounting for Multimorbidity in Clinical Guidelines\u2014Structured Examination of Exemplar Guidelines and Health Economic Modelling","author":"Guthrie B","year":"2017"},{"key":"bibr40-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2018.09.2843"},{"key":"bibr41-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.1002\/hec.985"},{"key":"bibr42-0272989X19868987","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X03261561"}],"container-title":["Medical Decision Making"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0272989X19868987","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0272989X19868987","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0272989X19868987","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T17:59:57Z","timestamp":1777658397000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0272989X19868987"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,20]]},"references-count":42,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2019,10]]}},"alternative-id":["10.1177\/0272989X19868987"],"URL":"https:\/\/doi.org\/10.1177\/0272989x19868987","relation":{},"ISSN":["0272-989X","1552-681X"],"issn-type":[{"value":"0272-989X","type":"print"},{"value":"1552-681X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,20]]}}}